Integrated Scanning and Ocular Tomography System and Method

ABSTRACT

Systems and methods of the present invention measure at least one reflecting surface of an object disposed along an optical path. In some embodiments a measured optical interference signal for each of at least three wavelengths of reflected light may be used to determine a modulation of frequency components of a Fourier series. Frequency components of a Fourier series may be transformed to spatial components that describe intensities and positions of light reflected along an optical path. Systems and methods of the present invention permit rapid measuring and may monitor corneal thickness during surgery. The invention may do so by integrating an ablation device and a measurement apparatus into a single system. An integrated scanning and monitoring system may include an ablative light source producing an ablative beam and a measurement light source producing a measurement beam.

CROSS-REFERENCE TO RELATED APPLICATION

This is a divisional application which claims priority from U.S. patentapplication Ser. No. 10/601,119 filed on Jun. 19, 2003, which claims thebenefit under 35 USC 119(e) of U.S. Provisional Patent Application No.60/392,330 filed on Jul. 27, 2002, the full disclosures of which areincorporated herein by reference.

BACKGROUND OF THE INVENTION

The present invention relates generally to measurements of tissues,optical elements and other structures, and, more particularly, tomethods and systems for integrated ocular tomography and scanning laserablation.

Corneal shape corrective surgeries are commonly used to treat myopia,hyperopia, astigmatism, and the like. Procedures employing an excimerlaser include LASIK (Laser Assisted In-Situ Keratomileusis), PRK (PhotoRefractive Keratectomy) and LASEK (Laser Subepithelial Keratomileusis).During LASIK, a suction ring is typically placed over sclera tissue (thewhite part of the eye) to hold the eye firmly. A surgeon first uses amicrokeratome with an oscillating steel blade to make a partial cutthrough a front surface of a cornea. A microkeratome automaticallypassing across a cornea creates a thin flap of clear tissue on a frontcentral part of an eye. A suction ring is then removed, and a flap islifted back to sufficiently expose tissue for ablation with a laser. Alaser is programmed to correct a desired amount of visual effect, anddirects a laser beam. A rapid, continuous emission of laser pulsesremoves very small precise amounts of corneal tissue. After irrigationwith saline solution, a corneal flap is folded back to adhere to itsoriginal position.

Precise measurement of corneal thickness may benefit LASIK and othercorneal shape corrective surgeries. An ability to monitor cornealthickness during surgery is desirable because it may facilitate improvedcontrol over ablation and may lead to more precise reshaping of acornea. Further, in situ surgical tomographic measurement of a corneamay prevent over and under correction with ablation and excessivethinning of a cornea having associated problems such as kera ectasia.

Problems encountered with techniques for measuring a tomography of acornea have often included a length of time required to measure cornealthickness and difficulty sampling corneal thickness over an area oftissue, as opposed to sampling thickness at a single point of tissue.Previous surgical systems have typically measured a central point orsmall central region of a cornea during surgery. Measuring a singlepoint or small central region is less than ideal because suchmeasurements typically represent only a small portion of a total treatedarea.

In light of the above it would be desirable to provide improved systemsand methods for measuring a thickness of a cornea during surgery.

SUMMARY OF THE INVENTION

The present invention is generally directed to systems and methodsmeasuring at least one reflecting surface of an object disposed along anoptical path. A measured optical interference signal for each of atleast three wavelengths of reflected light is used to determine afrequency component of a Fourier series. Frequency components of aFourier series may be transformed to spatial components. Spatialcomponents describe intensities and positions of light reflected alongan optical path. Systems and methods of the present invention permitrapid measuring and monitoring of corneal thickness during surgery.Specific embodiments of the invention provide simple and efficient waysof measuring tomography of a cornea during ablation. The invention maydo so by integrating an ablation device and a measurement apparatus intoa single system.

In a first aspect the invention comprises a method of measuring athickness of a tissue. The method includes reflecting at least threewavelengths of light from a tissue by directing a measurement light beamalong an optical path toward a tissue. An interference signal for eachof at least three wavelengths of reflected light is measured. Aseparation distance between positions of at least two reflecting tissuesurfaces along an optical path is determined by combining measuredinterference signals.

In various embodiments, a measurement light beam may comprise at leastthree light wavelengths simultaneously directed along a path toward atissue, and at least three interference signals may be measuredsimultaneously. Frequency components of a Fourier series may bedetermined from an interference signal for each of at least threewavelengths. Measured frequency components of a Fourier series may betransformed to spatial components. Spatial components describe positionsand intensities of a light beam reflected from a tissue along an opticalpath. A tomography of a tissue may be determined by directing ameasurement beam to several locations of a tissue. Locations may have atleast two reflecting tissue surfaces along an optical path. A light beammay be scanned from a first location to a second location. A firstlocation and a second location may be among locations used to determinea tomography of a tissue.

In some embodiments the invention comprises a method of treating atissue. A desired shape is formed in a tissue by directing an ablativelight beam toward a tissue. A tissue reflects at least three wavelengthsof light from a measurement light beam directed along an optical path.An interference signal for each of at least three wavelengths ofreflected light is measured. Positions of at least two reflecting tissuesurfaces along a optical path are determined by combining measuredinterference signals while an ablative light beam is directed toward atissue.

In additional embodiments a measurement light beam may comprise at leastthree wavelengths simultaneously directed along a path toward a tissueand at least three interference signals may be measured simultaneously.Frequency components of a Fourier series may be determined from aninterference signal for each of at least three wavelengths. Measuredfrequency components of a Fourier series may be transformed to spatialcomponents. Spatial components may describe positions and intensities ofa light beam reflected from a tissue along an optical path.

In some embodiments, the invention comprises a method of treating atissue. An ablative beam for ablating a tissue is directed via ascanning device to a tissue. A measurement beam for measuring a profileof a tissue is directed via a scanning device to a tissue. A path of anablative beam and a path of a measurement beam are substantiallyconcentric as directed onto a tissue.

In specific embodiments a path of an ablative beam and a path of ameasurement beam may be substantially coaxial as directed onto a tissue.A tissue may be measured intermittently at time intervals betweeninstances of ablation. A measurement beam for measuring a thickness of atissue may be directed to a tissue via a scanning device.

In another aspect, the invention comprises a system for measuring athickness of a tissue. A system comprises a light source emitting ameasurement light beam directed along an optical path toward a tissue.At least three wavelengths of a measurement light beam reflect from atissue. An interferometer generates an interference signal for each ofat least three wavelengths of a measurement light beam reflected from atissue. A processor determines a separation distance between positionsof at least two reflecting tissue surfaces along an optical path bycombining interference signals.

In some embodiments a measurement light beam may comprise at least threelight wavelengths simultaneously directed along a path toward a tissue,and at least three interference signals may be measured simultaneously.An interference signal of each of at least three light wavelengths maybe used to determine frequency components of a Fourier series. Aprocessor may transform frequency components of a Fourier series tospatial components. Spatial components may describe positions andintensities of a light beam reflected from a tissue along an opticalpath. An optical system may direct a measurement beam to severallocations of a tissue so as to determine a tomography of a tissue atlocations having at least two reflecting tissue surfaces along anoptical path. An optical system may scan a light beam from a firstlocation to a second location. A first location and a second locationmay be among locations used to determine a tomography of a tissue.

In many embodiments the invention comprises a system for treating atissue. A system comprises an ablative light source emitting an ablativelight beam. A light source emits a measurement light beam directed alongan optical path toward a tissue. At least three wavelengths of ameasurement light beam reflect from a tissue. An interferometergenerates an interference signal for each of at least three wavelengthsof a measurement light beam reflected from a tissue. A processorcontrols an ablative light beam and determines positions of at least tworeflecting tissue surfaces along an optical path by combininginterference signals.

In specific embodiments a measurement light beam may comprise at leastthree wavelengths simultaneously directed along an optical path toward atissue, and at least three interference signals may be measuredsimultaneously. An interference signal of each of at least threewavelengths may be used to determine a frequency component of a Fourierseries. A processor may transform frequency components of a Fourierseries to spatial components describing positions and intensities of alight beam reflected from a tissue along an optical path.

In some embodiments the invention comprises an apparatus for treatingtissue. An ablative light source produces an ablative light beam. Ameasurement light source produces a measurement light beam. A scannerreceives an ablative light beam from an ablative light source and ameasurement light beam from a measurement light source. A scannerincludes optical elements directing an ablative beam and a measurementbeam to locations across a tissue so as to ablate a tissue with anablative beam and measure a profile of a tissue with a measurement beam.A path of an ablative beam and a path of a measurement beam aresubstantially concentric at a tissue. A path of an ablative beam and apath of a measurement beam may be substantially coaxial as directed ontoa tissue. A processor may be electrically connected with an ablativelight source and a measurement light source. A processor may control anablative light beam and a measurement light beam.

In specific embodiments the invention comprises an apparatus fortreating tissue. An ablative light source produces an ablative beam. Abeam delivery device directs an ablative beam onto a tissue. Amicroscope has a viewing port. An optical pachymeter emits a measurementlight beam directed along an optical path toward a tissue. At leastthree wavelengths of a light beam reflect from a tissue. An opticalpachymeter comprises an interferometer generating an interference signalfor each of at least three wavelengths of a measurement light beamreflected from a tissue. A pachymeter includes a processor determining aseparation distance between positions of at least two reflecting tissuesurfaces along an optical path by combining interference signals. Ameasurement light beam may comprise at least three wavelengthssimultaneously directed along a path toward a tissue, and at least threeinterference signals may be measured simultaneously. An interferencesignal of each of at least three wavelengths may be used to determinefrequency components of a Fourier series. A processor may transformfrequency components of a Fourier series to spatial components. Spatialcomponents may describe positions and intensities of a light beamreflected from a tissue along an optical path.

In another aspect the present invention comprises a method of measuringa separation distance between positions of at least two reflectionsalong an optical path. At least three wavelengths of light are reflectedat the positions by directing a measurement light beam along an opticalpath. An interference signal for each of the at least three wavelengthsof reflected light is measured. A separation distance between positionsof at least two reflections along an optical path is determined bycombining interference signals.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a laser eye surgery system incorporating the presentinvention.

FIGS. 2 and 3 schematically illustrate a laser beam delivery system forselectively directing a laser beam onto a corneal tissue forincorporation with the present invention.

FIG. 4 is a schematic view of a laser delivery system incorporating atomography system in accordance with an embodiment of the invention.

FIG. 5 is a schematic view of an alternate laser delivery system forincorporating a tomography system in accordance with another embodimentof the present invention.

FIG. 6 is a schematic illustration of a Fourier reconstructiontomography system for rapidly measuring a shape and thickness of acornea in accordance with an embodiment of the present invention.

FIG. 7 illustrates an reference spectrum obtained from a calibrationmeasurement of a system as in FIG. 6, in accordance with an embodimentof the present invention.

FIG. 8 illustrates an interference spectrum obtained from a corneameasurement with a system as in FIGS. 6 and 7.

FIG. 9 illustrates components of an interference signal in accordancewith an embodiment of the present invention.

FIG. 10 illustrates measured reflected light intensities and positionsalong an optical path for a cornea after LASIK eye surgery, inaccordance with an embodiment of the present invention.

FIG. 10A illustrates phantom signals that may occur in an embodiment ofthe present invention.

FIG. 11 is a schematic illustration of a tomographic system inaccordance with an embodiment of the present invention.

FIGS. 11A-11D illustrate dimensions, wavelengths and signals inaccordance with an embodiment of the present invention.

FIG. 12 is a schematic diagram illustrating integration a tomographysystem with an operating microscope in accordance with an embodiment ofthe invention.

DESCRIPTION OF THE SPECIFIC EMBODIMENTS

The present invention is particularly useful for enhancing accuracy andefficacy of laser eye surgical procedures, such as photorefractivekeratectomy (PRK), phototherapeutic keratectomy (PTK), laser assisted insitu keratomileusis (LASIK), laser subepithelial keratomileusis (LASEK)and the like. Preferably, the present invention can provide enhancedoptical accuracy of refractive procedures by improving a cornealablation of a refractive treatment program. Hence, while the system andmethods of the present invention are described primarily in a context ofa laser eye surgery system, it should be understood techniques of thepresent invention may be adapted for use in alternative eye treatmentprocedures and systems such as spectacle lenses, intraocular lenses,contact lenses, corneal ring implants, collagenous corneal tissuethermal remodeling, and the like.

Systems and methods of the present invention permit rapid measurementsof an object having reflecting and scattering surfaces, and are able torapidly measure a thickness and a tomography of a cornea. Systems andmethods of the present invention may be integrated into a surgical laserfor sculpting a corneal surface. In embodiments using severalwavelengths of light and spectral decomposition techniques cornealthickness may be obtained very rapidly.

As used herein an “optical tissue surface” may encompass a theoreticaltissue surface derived from an optical measurement of light refractionof an eye (exemplified by wavefront sensor data and manifest refractiondata), an actual tissue surface, and/or a tissue surface formed forpurposes of treatment (for example, by incising corneal tissues so as toallow a flap of the corneal epithelium to be displaced and expose theunderlying stroma during a LASIK procedure).

A laser ablating a surface of an eye is illustrated in FIG. 1. A lasereye surgery system 10 includes a laser module 12 that produces a laserbeam 14. An eye 2 is illustrated in cross section as being ablated by alaser system 10 having a laser module 12 emitting a beam 14 of anablative light energy. An eye 2 has a cornea 4. A cornea 4 has a frontsurface 6 and a back surface 7. During surgery a flap 8 of tissue isoften excised from a cornea 4. A bed 10 of remaining tissue is exposedwhen a flap 8 is resected. In some instances, a thickness between afront surface 6 and a back surface 7 may vary across a corneal tissue.Laser delivery optical system 16 is in a path of laser beam 14. Deliveryoptical system 16 direct laser beam 14 to an eye 2. An input device 20is used to align laser system 10 in relation to an eye 2. A microscope21 is often used to image a cornea 4 of an eye 2. A display 19 isviewable by a user of system 10. A processor 22 of system 10 includes atangible media 29. A tomography system 9 has a measurement beam 13.Elements of delivery optical system 16 are common to both measurementbeam 13 and laser beam 14. In various embodiments, a laser eye surgerysystem 10 includes at least some portions of a Star S3 Active Trak®Excimer Laser System available from VISX, INCORPORATED of Santa Clara,Calif.

While an input device 20 is here schematically illustrated as ajoystick, a variety of input components may be used. Suitable inputcomponents may include trackballs, touch screens, or a wide variety ofalternative pointing devices. Still further alternative input componentsinclude keypads, data transmission mechanisms such as an Ethernet,intranet, internet, a modem, or the like.

A laser module 12 generally comprises an excimer laser and ideallycomprises an argon-fluoride laser producing pulses of laser light havinga wavelength of approximately 193 nm. A pulse of laser light typicallyhas a fixed pulse duration having a full width half maximum (FWHM) ofabout 15 nano seconds during a treatment. Laser module 12 is preferablydesigned to provide a feedback-stabilized fluence at the patient's eye,delivered via delivery optical system 16. The present invention may alsobe useful with alternative sources of ultraviolet or infrared radiation,particularly those adapted to controllably ablate a corneal tissuewithout causing significant damage to adjacent and/or underlying tissuesof the eye. The laser system may include, but is not limited to, excimerlasers such as argon-fluoride excimer lasers (producing laser energywith a wavelength of about 193 nm), solid state lasers, includingfrequency multiplied solid state lasers such as flash-lamp and diodepumped solid state lasers. Exemplary solid state lasers include UV solidstate lasers (approximately 193-215 nm) such as those described in U.S.Pat. Nos. 5,144,630 and 5,742,626, Borsuztky et al., “Tunable UVRadiation at Short Wavelengths (188-240 nm) Generated by Sum FrequencyMixing in Lithium Borate”, Appl. Phys. 61:529-532 (1995), and the like.Laser energy may comprise a beam formed as a series of discreet laserpulses. A variety of alternative lasers might also be used. Hence,although an excimer laser is the illustrative source of an ablativebeam, other lasers may be used in the present invention.

Laser module 12 and delivery optical system 16 will generally directlaser beam 14 to an eye 2 of patient under direction of a processor 22.Processor 22 will often selectively adjust laser beam 14 to exposeportions of a cornea to pulses of laser energy so as to effect apredetermined sculpting of a cornea and alter refractive characteristicsof an eye. In many embodiments, both laser 14 and a delivery opticalsystem 16 will be under computer control of processor 22 to effect adesired laser sculpting process, with processor 22 effecting (andoptionally modifying) a pattern of laser pulses. A pattern of pulses maybe summarized in a treatment table listing of machine readable data of atangible media 29. A treatment table may be adjusted according tofeedback input into processor 22 from an automated cornea shape analysissystem (manually input into processor 22 by a system operator) inresponse to feedback data provided from an ablation monitoring systemfeedback system.

Feedback is provided by a rapid tomographic measurement system 9integrated with a laser treatment system 10, and processor 22 maycontinue and/or terminate a sculpting treatment in response to feedback,and may optionally also modify a planned sculpting based at least inpart on feedback. Information related to a surgical procedure is shownon a display 19. Information on display 19 may include a profile incross section 18 of a corneal tissue as feedback measured by a rapidtomographic measurement system 9. Display 19 may also show a video imageof a cornea 4 as seen through a microscope 21. A CCD camera 17 mountedto a microscope 21 is in electrical communication with a display 19.

Laser beam 14 may be adjusted to produce a desired sculpting using avariety of alternative mechanisms. A laser beam 14 may be selectivelylimited using one or more variable apertures. An exemplary variableaperture system having a variable iris and a variable width slit isdescribed in U.S. Pat. No. 5,713,892, the full disclosure of which isincorporated herein by reference. A laser beam may also be tailored byvarying a size and offset of a laser spot from an axis of an eye, asdescribed in U.S. Pat. No. 5,683,379, and as also described inco-pending U.S. patent application Ser. No. 08/968,380, filed Nov. 12,1997; and Ser. No. 09/274,999 filed Mar. 22, 1999, the full disclosuresof which are incorporated herein by reference.

Still further alternatives are possible, including scanning a laser beamover a surface of an eye and controlling a number of pulses and/or dwelltime at each location, as described, for example, by U.S. Pat. No.4,665,913 (the full disclosure of which is incorporated herein byreference); using masks in an optical path of laser beam 14 which ablateto vary a profile of a beam incident on a cornea, as described in U.S.patent application Ser. No. 08/468,898, filed Jun. 6, 1995 (the fulldisclosure of which is incorporated herein by reference); hybridprofile-scanning systems in which a variable size beam (typicallycontrolled by a variable width slit and/or variable diameter irisdiaphragm) is scanned across the cornea as described in U.S. Pat. Nos.6,319,247; 6,280,435; and 6,203,539, the full disclosures of which areincorporated herein by reference; or the like. The computer programs andcontrol methodology for these laser pattern tailoring techniques arewell described in the patent literature.

Additional components and subsystems may be included with laser system10, as should be understood by those of skill in the art. For example,spatial and/or temporal integrators may be included to control adistribution of energy within a laser beam, as described in U.S. Pat.Nos. 5,646,791 and 5,912,779 the full disclosures of which areincorporated herein by reference. An ablation effluent evacuator/filter,and other ancillary components of a laser surgery system that are notnecessary to an understanding of the invention, which may be optionallyemployed, need not be described in detail for an understanding of thepresent invention.

Processor 22 may comprise (or interface with) a conventional PC systemincluding standard user interface devices such as a keyboard, a displaymonitor, and the like. Processor 22 will typically include an inputdevice such as a magnetic or optical disk drive, an internet connection,or the like. Such input devices will often be used to download acomputer executable code from a tangible storage media 29 embodying anymethods of the present invention. Tangible storage media 29 may comprisea floppy disk, an optical disk, a data tape, a volatile or non-volatilememory, or the like, and a processor 22 will include memory boards andother standard components of modern computer systems for storing andexecuting a computer program code. Tangible storage media 29 mayoptionally embody wavefront sensor data, wavefront gradients, awavefront elevation map, a treatment map, a corneal topography map, ameasurement of a refraction of an eye, and an ablation table.

Referring now to FIG. 2, a laser beam delivery system 16 for directing alaser beam 14 at an eye 2 will often include a number of mirrors 30, aswell as one or more temporal integrators 32 which may adjust (orotherwise tailor) an energy distribution across a laser beam. Lasermodule 12 will often comprise an excimer laser as described above.

In an exemplary embodiment, a variable aperture 34 changes a diameterand/or slot width to profile laser beam 14, ideally including both avariable diameter iris and a variable width slot. A prism 36 separateslaser beam 14 into a plurality of beamlets, which may partially overlapon eye 2 to smooth edges of an ablation or “crater” formed from eachpulse of a laser beam.

Referring now to FIGS. 2 and 3, an offset module 38 includes motors 40which vary an angular offset of an offset lens 42, and which also changea radial orientation of an offset. Hence, offset module 38 canselectively direct laser beam 14 at a desired lateral region of acornea. A system and method for using a laser beam delivery system 16and an offset module 38 are more fully described in U.S. Pat. Nos.6,331,177; 6,203,539; 5,912,775; and 5,646,791 the full disclosures ofwhich are incorporated herein by reference.

FIG. 4 illustrates an embodiment of an integrated scanning laser andocular tomography system 50 having separate scanning modules 52A and52B. Scanning device 52A having mirrors 56E and 56F scans ablative lightbeam 14 over a cornea 4 of an eye 2. Scanning device 52B scans ameasurement light beam 13 over a cornea 4 of an eye 2. With anembodiment as in FIG. 4, paths of an ablative light beam 14 and ameasurement light beam 13 may be combined after passing through scanningmodules 52A and 52B. It is understood that the scanning modules 52A and52B may include any suitable arrangement of optical elements fordelivering beams to the cornea 4. Several known methods and systems forablating tissue surfaces with laser beams can be combined with ameasurement light source module and a scanning module as illustrated inFIG. 4.

FIG. 5 illustrates an integrated scanning and ocular tomography system20 including a scanning device 52 for delivering an ablative beam 14 oflight energy from an ablative light energy source module 12 to a cornea4 of an eye 2. An ablative light energy source module 12 typicallyincludes a laser as the light energy source as described above. Ameasurement beam 13 of light energy from a measurement light energysource module 9 also passes through the scanning device 52 whichdelivers a measurement beam 13 to a cornea 4. A measurement light energysource module 9 will typically include a source of light energy andoptical elements for generating measurement data. An ablative beam 14and measurement beam 13 typically have different wavelengths. Forexample, an ablative light energy beam 14 will typically have awavelength of about 200 nm, preferably 193 nm as described above, andmeasurement beam 13 will typically have a wavelength between about 700nm and 1700 nm. Paths of laser beam 14 and measurement beam 13 arecombined with a mirror 60 before scanning device 52. Mirror 60preferably has a dielectric coating selectively reflecting ultravioletlight and passing visible light. Such mirrors are well known in the art.For simplicity, a scanning device 52 is shown to include a pair ofmirrors 56A, 56B. A processor 22 is provided to control operation of thesystem 10 as described above, and is in electrical communication withscanning mirror pair 56A, 56 B.

In an embodiment of a laser delivery system integrated with a tomographysystem, an ablative beam 14 and measurement beam 13 are concentric sothat ablation and measurement may take place at the same location. Tofurther improve accuracy, an ablative beam 14 and measurement beam 13are desirably coaxial and concentric as directed toward a cornea 4. Acoaxial and concentric arrangement of measurement beam 13 and ablativebeam 14 eliminates axial displacement errors that may be caused byangular variations between the beams. A terminus 72 of optical fiber 70emits measurement light beam 13. A scanning device 52 includes opticalelements configured to focus ablative and measurement beams confocallyand coaxially. For example, lens 64 forms an image of an aperture inmodule 34 near a surface of cornea 4, and lens 64 also forms an image ofa terminus 72 of optical fiber 70 near a surface of cornea 4. Mirrors 62and 66 reflect light from measurement beam 13 and ablative light beam 14to direct both measurement light beam 13 and ablative light beam 14 to acornea 4. Use of the scanning device 52 to deliver both an ablative beam14 and a measurement beam 13 may provide effective delivery of bothbeams confocally and coaxially, and avoids a need to introduce twoseparate sets of beam delivery apparatus.

Processor 22 is in electrical communication with a measurement lightsource module 9 to control generation of a measurement beam 13 and toprocess measurement data. For example, a measurement beam 13 maygenerate an interference pattern with reflection from a cornea 4 andreflection from a reference surface. Processor 22 processes measuredinterference patterns to extract tomography data of a cornea 4,preferably at a sufficient processing rate to allow real time monitoringof ocular tomography during ablation by ablative beam 14. For instance,a processing rate may be higher than a pulse repetition rate of a laserin an ablative light source module generating ablative beam 14. In thisway, the ocular tomography can be monitored by processor 22 viameasurement light source module 9 on a pulse-by-pulse basis. As aresult, substantially simultaneous ablation and measurement may beaccomplished.

A target tomographic shape of a cornea 4 may be preset based on adiagnosis of the patient, and be stored in a memory of processor 22. Aprocessor 22 may compare measured tomography with a target tomographyfor a tissue shape in real time to determine an ablative depth needed toachieve a targeted tomography. A processor 22 may dynamically directoperation of an ablative light source module 12 and a scanning device 52to adjust energy and/or positioning of ablative beam 14 and scanablative beam 14 across a cornea 4 at desired locations with appropriateintensity levels to achieve a desired beam exposure and targetedcorrection in real time.

A processor 22 can also provide temporal control of the delivery of theablative beam 14 and measurement beam 13. Although ablation andmeasurement can take place simultaneously, the ablative process mayperturb the measurement beam 13 and lead to inaccurate measurements.Some embodiments provide temporal interleaving of ablation andmeasurement to ensure accuracy. A processor 22 may direct operation ofan ablative light source module 12 and measurement light source module 9to produce an intermittent ablative beam 14 and intermittentmeasurements of beam 13 that alternate in time. Alternately, ameasurement beam 13 may be measured continuously, while an ablative beam14 is intermittent. A processor 22 may direct operation of a measurementlight source module to take measurements in time intervals betweenpulses of an intermittent ablative beam 14.

A variety of methods of generating and using a measurement beam 13 fortomography measurement may be adapted to a laser system 10. Ameasurement beam 13 may be generated by a variety of sources including,for instance, a white light source, a super-luminescent diode, and atunable laser source providing laser light tuned to a specificwavelength. By way of example, the following describes a Fourierreconstruction interferometer apparatus and an optical coherencetomography apparatus. Each apparatus includes a light source and opticalelements that comprise a measurement light source module 9 emitting ameasurement beam 13 as described above.

Fourier Reconstruction Interferometer

FIG. 6 illustrates an embodiment of a tomographic measurement systemthat may be integrated with a laser system 10 as described above. AFourier reconstruction interferometer apparatus 100 measures atomography of corneal tissue. Many elements of interferometer apparatus100 are preferably comprised within light source module 9 as describedabove. A processor 22 is electrically connected with a scanning module52 as described above. In an alternate embodiment surface topography maybe measured. A super luminescent diode 102 emits a beam of light energyand is electrically connected with a super luminescent diode driver 104.A super luminescent diode driver 104 is electrically connected withprocessor 22. While any super luminescent diode emitting any wavelengthof light can be used, a preferred diode emits infrared light at about1500 nm. A commercially available super luminescent diode 102 and diodedriver may be comprised within a single subsystem. For example, aLightPAK™ LP-2000 intelligent optical source available from FIBERBYTE ofAdelaide, SA, Australia includes many super luminescent diodes and adiode driver. A super luminescent diode emits light at about 1500 nm andhas a full width half maximum (FWHM) of about 40 nm. An InGaAs linearimage sensor 108 is in electrical communication with a sensor module 106having a driver amplifier circuit and control subsystem. Examples of asuitable linear image sensor and sensor module are a G8161-512 S LinearImaging Sensor and a C7557 Sensor Module, both available from HAMAMATSUof Hamamatsu City, Japan.

A lens 110 collimates light emitted by super luminescent diode 102. Anetalon 112 selectively passes frequencies of light emitted by superluminescent diode 102. The frequencies of light passed by an etalon 112are frequency components of a Fourier series. A lens 114 focuses lightinto a first end 115 of first optical fiber 116. An optional mirror 113between lens 114 and first end 115 reflects focused light. A 50/50coupler 118 combines light from a first optical fiber 116 with lightfrom a second optical fiber 120. Light entering a first optical fiber116 is enters a second optical fiber 120 at 50/50 coupler 118 and isemitted from a first end 124 of second optical fiber 120. Lens 122collimates light emitted by a first end 124. Collimated light passesthrough scanning module 52 as described above. A lens 123 images andfocuses emitted light from scanning module 52. Imaged and focused lightis incident on cornea 4. Light reflected from cornea 4 travels throughlenses 122 and 123, enters a first end of a second optical fiber 120,and is emitted by a second end 125 of second optical fiber 120.

A lens 128 collimates light emitted by a second end 126 of a firstoptical fiber 116. A mirror 130 reflects light back toward lens 128 anda second end 126. Light reflected from mirror 130 is combined with lightreflected from cornea 4 at 50/50 coupler 118. Combined light is emittedfrom a second end 125 of a second fiber 120. An optional mirror 132reflects light toward a lens 134. A lens 134 collimates light emitted bya second end 125. A grating 136 diffracts light. A lens 138 focuseslight onto a linear image detector 108 as described above. A separationdistance between lens 138 and grating 136 may typically be about a focallength of lens 138, and a separation distance between a lens 138 and alinear image sensor 108 may typically be about a focal length of a lens138. Alternate embodiments may use different optical components andseparation distances to separate wavelengths of light at a detector.

Cornea 4 is positioned so that an optical path length of light travelingto a reference mirror 130 from source 102 will be near an optical pathlength of light traveling to a cornea 4 from a source 102. A boundary ofa measured tissue, for example an apex of a front surface of a cornea,is positioned with control and at a location having an optical pathlength near that of a reference mirror 130.

An etalon can be used to provide several light frequency components andwavelengths of a Fourier series. For an illustrative optical path lengthof an etalon of 2 mm and an illustrative wavelength of light of 800 nm,an integer number of 2500 oscillations of light will occur. Additionallight wavelengths are spaced at spectral line widths of about 0.32 nm.For a light source having a full width half maximum of 32 nm and acentral wavelength of about 800 nm, about 100 frequencies of light areavailable as frequency components of a Fourier series. An inverseFourier transform is made with frequencies of light that are measured.While over 2500 wavelengths are theoretically possible, an inverseFourier transform will provide valuable information even with a band ofwavelengths having a limited number of measured frequencies. An inverseFourier transform of measured interference signals for wavelengthshaving spectral line widths of 0.32 nm will determine intensities ofreflected light at 0.32 nm increments along an optical path.

Frequencies and wavelengths of light can be generated at any wavelength.For example, white light having a wavelength between about 400 and 800nm may be used. Wavelengths at about 1500 nm are desirable as longerwavelengths scatter light less than shorter wavelengths and willpenetrate into a tissue structure. Wavelengths at about 10 um may beused to a measure topography of a surface appearing rough and diffusewhen illuminated with shorter wavelengths of light, for example visiblewavelengths.

An etalon of any length and finesse can be used to generate frequencycomponents at any desired spectral line width. While at least 3wavelengths of reflected light are used to generate frequencycomponents, in general more frequency components produce more accuratemeasurements. In some embodiments 10 or more, wavelengths of light arereflected from a cornea to generate frequency components. As describedabove 100 or more wavelengths of light may be generated and reflectedfrom a cornea. A linear image sensor may have at least 500 pixelelements, and 200 or more wavelengths may be generated and reflectedfrom a tissue. Light from a broad spectral source, for example a whitelight source, may be passed though an etalon to generate light havingthousands of frequency components of a Fourier series for reflectingfrom a cornea.

As illustrated in FIG. 7, reference intensity 150 in arbitrary units(A.U.) is measured for a wavelength 152 of several wavelengths of lightenergy emitted by a super luminescent diode. Such a measurement may betaken with light reflected from a reference mirror 130 while areflecting surface such as a cornea 4 is removed from an optical path oflight emitted from a first end 124 of a second optical fiber 120 asdescribed above. Reference intensity 150 generally matches a spectraldistribution of light energy emitted by a super luminescent diode 102 asdescribed above. While a value for any wavelength can be measured,wavelengths within a full width half maximum band of wavelengths emittedby a superluminescent diode are often measured.

To determine a tomography of an object, a cornea is positioned along anoptical path of emitted light as described above. Light emitted from asuper luminescent diode is reflected and combined as described above. Asshown in FIG. 8, an interference signal 160 for each of severalwavelengths of light 156 is measured at linear image detector 108 withlinear image sensor 108 and sensor module 106, as described above.Values above a reference intensity value for a given wavelength resultfrom constructive interference and values below a reference intensityvalue for a given wavelength result from destructive interference.Measured signals are normalized with respect to reference values asdescribed above to provide a normalized signal intensity 154 for each ofseveral wavelengths 156.

A phase plot of a reflected tissue component 162 of interference signal160 at a wavelength of light is illustrated in FIG. 9. An intensity of areference signal as described above is modulated by light reflected froma tissue. A phase plot of a reflected tissue component 162 of aninterference signal 160 has a real component 164 and an imaginarycomponent 166. A real component 164 is measurable by linear image sensor108 as a modulation of a reference signal as described above. Animaginary component 166 of a reflected tissue component 162 may bedetermined from a real component 164. In an embodiment, an angle of animaginary component 166 is determined with an arccosine of a realcomponent 164. In some embodiments a magnitude of a reflected tissuecomponent 162 may be determined by selecting a maximum amplitudemodulation from among several normalized signal intensities havingsimilar reflective properties in tissue.

Each interference signal has an associated wavelength of light. Aspatial frequency of light is determined by a speed of light in tissueand its oscillation frequency. An index of refraction, n, determines aspeed of light in a tissue. A cornea has an index of refraction of about1.377 and an aqueous humor of an eye has an index of refraction of about1.33. A spatial frequency for a wavelength of light is calculated for anappropriate index of refraction.

An apparatus 100 calculates tissue tomography by combining spatialfrequency components to determine a position and intensity of lightreflected along an optical path as illustrated in FIG. 10. Aband-limited inverse Fourier transform can be used to combinefrequencies to determine an intensity and position of light reflectedalong an optical path. A plot of an intensity 168 of reflected light ata position 170 relative to a reference mirror 130 as described above isshown in FIG. 10. As illustrated, peaks of three reflecting surfaces areillustrated. A first peak 172 is located at a position indicating firstreflecting surface of a cornea. A second peak 174 is located at aposition indicating an interface between a LASIK flap and stromal bead.A third peak 176 is located at a position indicating a posterior surfaceof a cornea.

In some embodiments, an inverse Fourier transform may result in phantomintensities of reflected light at phantom positions as illustrated inFIG. 10A. Phantom intensities having positions may arise from incompletephase information of a measured interference signals. Phantom peaks172A, 174A and 176A illustrate phantom intensities symmetricallypositioned in relation to peaks 172, 174 and 176 along an optical pathin relation to an etalon and a reference mirror. Phantom intensities andpositions may be isolated so as not to interfere with actual tissuesignals by controlling alignment of a tissue sample in relation to areference mirror and a length of a tissue sample in relation to a lengthof an etalon. For example, a tissue sample may have an optical pathlength less than about half of an optical path length of an etalon, anda boundary of a measured surface may be positioned at an optical pathlength position nearly matching an optical path length of referencemirror as described above. A plot of intensities at positions may havean optical path length matching an optical path length of an etalon. Forexample an etalon may have an optical path length of 2 mm as illustratedin FIG. 10A. A dimension along a cornea is determined by dividing anoptical path length by an index of refraction of a cornea.

By controlling a position of a cornea to be at a generally knownlocation in relation to an etalon, phantom intensities at phantompositions may appear at locations removed from true corneal reflectionsand be excluded from tomographic measurements. As illustrated in FIG.10A, phantom peaks 172A, 174A and 176A occur at locations removed frompeaks 172, 174 and 176. As illustrated in FIG. 10A, a position is inrelation to a reference mirror. By controlling a position of an anteriorsurface of a cornea 4 to be at an optical path length near a referencemirror and assuming that a distance through a cornea is less than about1 mm of optical path length, phantom peaks 172A, 174A and 176A may beexcluded from tomographic measurements.

Scanning a light beam across a cornea 4 and measuring interferencesignals at several locations across a cornea can make athree-dimensional tomography model of optical properties of a cornea 4.Several plots for each of several known locations are made asillustrated in FIG. 10. These plots of intensity are combined to makethree dimensional tomography maps of corneal tissue.

In alternate embodiments, a controlled laser source emitting light atselected wavelengths of a Fourier series may be used as a light source.Several measurements may be sequentially taken at controlled wavelengthsto generate interference signals for each of several wavelengths of aFourier series. An interferometer having an optical path with a largecross section of several mm, for example a Twyman Green interferometer,may be used to generate two-dimensional interference signals on twodimensional area of a CCD array. Several optical fibers, each measuringa tomography along an optical path as described above, may be directedat a cornea. An interferometric topography apparatus measuring severalpoints on a cornea with several optical fibers is described in U.S. Pat.No. 5,317,389, the full disclosure of which is incorporated herein byreference.

Optical Coherence Tomography

FIG. 11 shows an optical coherence tomography (“OCT”) apparatus 200using a short coherence length light source for range measurements basedon principles similar to white light interferometry. An OCT apparatusmeasures a pachymetry (thickness) of a cornea and may be scanned acrossa cornea to measure a tomography of a cornea. Systems and methods formeasuring a tomography of a cornea are described in U.S. Pat. Nos.6,004,314, 5,491,525 and 5,493,109, the full disclosures of which areincorporated herein by reference. FIG. 11 illustrates an embodiment of asystem that may be integrated with a laser system 10 as described above.Many elements of tomography apparatus 200 are preferably included withinlight source module 9 as described above. An apparatus 200 includes aradiation source 203 with a short coherent length and a Michelsoninterferometer 205 for measuring a thickness d of an object 201 such asthe cornea. A radiation source 203 may be a super-luminescent diodehaving a coherence length in a range of 10-15 μm.

An interferometer 205 includes a measuring branch 211, a referencebranch 213, an illumination branch 216, and an observation branch 209,which are connected to one another by a 50/50% coupler 217. A radiationdetector 207 and associated evaluation unit 210 are disposed withinobservation branch 209. A measured object 201 is arranged withinmeasuring branch 211. Disposed just downstream of the coupler 217 is apolarization control unit 219A in the measuring branch 211 and anotherpolarization control unit 219B in the reference branch 213. A radiationconductor 220A with detachable coupling 221A is connected to thepolarization control unit 219 a in the measuring branch 211, which leadsto a measuring unit 223. A measuring unit 223 is also connected via adetachable coupling 224 a to another end of the radiation conductor220A. A measuring unit 223 has a lens 225 for collimating radiationpassing through radiation conductor 220A. A focusing lens 226 focusesemitted radiation and collects radiation reflected from surfaces 227A,227B of an object 201. A focusing lens 226 may be arranged so thatradiation is focused at a back surface 227B having a very minimal degreeof reflection in order to measure radiation reflected from a backsurface 227B.

A radiation conductor 220B with detachable coupling 221 b is alsoconnected to a polarization control unit 219B of a reference branch 213,which leads to a reference unit 229 and a wavelength variator element215, and a reflector 230 connected downstream thereof. Another end of aradiation conductor 220B is also connected via a detachable coupling 224b to a reference unit 229. In a reference unit 229, radiation thatpassed through a radiation conductor 220B is collimated through a lens231 and beamed into a variator 215. Radiation is passed in the referencebranch 213 and measuring branch 211 in such a way that the differencesin dispersion in both branches 211, 213 can be disregarded, therebypreventing a dispersal of the interference signal.

A wavelength variator 215 has a refractive index n_(e), and periodicallychanges an optical path length and wavelength of a beam in the referencebranch 213 through natural rotation around a rotational axis 237. Across-sectional area of a variator 215 on which a reference beam 241A ofa reference branch 213 impinges is at least quadrilateral so that areference beam path in a variator 215 is reflected at least twice at itsinner surfaces. A reference beam 241E leaving a variator 215 can bereflected back, typically on itself, by a fixed reflector 230. In anembodiment, dimensions of side surfaces of the variator 215, a point ofincidence of radiation thereon, and a refractive index of a variatormaterial may be selected so that a wavelength difference achievable withrotation of variator 215 is approximately linear over an angle ofrotation. Linearity provides a narrow bandwidth Doppler frequency shiftto light emitted from a reference unit 220. A narrow bandwidth of aDoppler frequency shift permits good filtration, thereby producing ahigh signal-to-noise ratio measurement signal.

In a specific embodiment illustrated in FIG. 11, a coupler 217,polarization control units 219A, 219B, radiation source 203, radiationdetector 207, reflector 230, lens 231, variator 215, and evaluation unit210 are housed in a single device. A measuring unit 223 is linked via aradiation conductor 220A of an appropriate length to a remainder ofapparatus 200, and is coupled to a scanning device 52 as described abovefor delivering a measurement beam to a cornea.

In many embodiments, an etalon 112 is positioned along an optical pathof an illumination branch 216 of an interferometer as described abovefor selectively transmitting light as frequency and wavelengthcomponents of a Fourier series. Transmitted light is reflected from acornea and combined as described above. Rotation of a variator 215produces a Doppler shifted interference signal for each of severaltransmitted and reflected wavelengths. Alternatively, a reference mirrormay be translated along an optical path. For example, reflector 230 maybe movably mounted so as to translate along an optical path of referencebeam 241 e. Interference signals for each of several wavelengths ofreflected light are measured from a signal comprising severalinterference signals. A measured interference signal for each of severalwavelengths of reflected light is determined by taking a Fouriertransform of a measured signal comprising several signals from severalwavelengths of reflected light. Alternatively, a measured interferencesignal for each of several wavelengths of reflected light may bedetermined by least squares fitting of a measured interference signal.As transmitted and reflected wavelengths may be known based onproperties of an etalon and a light source, least squares fitting to ameasured signal may determine measured amplitudes and phases for each ofseveral interference signals from a measured signal comprising severalsignals.

Physical dimensions and signals are illustrated for an embodiment inFIG. 11A. An etalon has an optical path length of 2 mm as describedabove, and a source emits light having a wavelength 302 centered near800 nm and a spectral band of wavelengths with a full width half maximumof 32 nm. Along a 2 mm optical path length of an etalon 2500 frequencyoscillations 304 of light having a wavelength 306 of 800 nm (8×10⁻⁷ m)will occur. A moving reference mirror has an optical path lengthvelocity 308 of 1 meter per second (twice a velocity of a referencemirror) and produces a central Doppler shifted interference signal at atemporal frequency 310 of 1.25 MHz (1.25×10⁶ cycles/s) and a spatialfrequency 312 of 1.25×10⁶ cycles per meter for a central wavelength of800 nm. Additional wavelengths of light emitted by a light source aretransmitted by an etalon and reflected from a cornea as described above.A wavelength 306 of additional frequencies of transmitted and reflectedlight are determined by a number of oscillations 304. A difference inwavelength 314 illustrates a spectral line width among transmittedwavelengths of light. A Doppler frequency (Hz) 315 illustrates afrequency at which each spectral component is measured at a detector207. A difference in Doppler frequency 316 illustrates sidebandfrequencies at 500 Hz intervals about a central frequency of 1.25 MHz. Aspatial frequency 318 in cycles per mm illustrates spatial frequenciesof each wavelength of transmitted and reflected light. A difference inspatial frequency 320 illustrates a difference in spatial frequencybetween adjacent wavelengths of light.

Each interference signal may be measured with a composite signal from asingle detector 207 with a measured energy detector signal dataacquisition rate of at least 5 MHz and a spatial sampling density of atleast about 5000 measured energy detector signal data samples per mm. AFourier transform of such a measured composite signal may determine ameasured interference signal for each of several wavelengths ofreflected light.

FIG. 11B illustrates a composite signal 330 of an intensity 332 at aposition 334 of a moving reference mirror as described above. In someembodiments, a mirror may not move an optical path length by an entirelength of an etalon. For example, a mirror may move 0.25 mm to vary anoptical path by 0.5 mm for an Etalon having a length of 2 mm. A signalmay be padded with any arbitrary value, for example 0, to complete adata set in preparation for Fourier spectral analysis. A measurementdata sampling frequency may be an integer multiple of Fourierfrequencies passed by an etalon. For example, for 2500 oscillationsalong a 2 mm optical path, spatial frequencies of 1250 cycles per mm arepresent, and a data sampling frequency may be 5000 cycles per mm andfour times a transmitted optical signal spatial frequency. For ameasurement having 1250 samples over a 0.5 mm length and an etalonhaving an optical path length of 2.0 mm as illustrated in FIG. 11B, adata set may be padded with a value of zero for 3750 values from 0.5 mmto 2.0 mm. Alternatively, least squares regression may be used to fit adata set of 1250 samples over a 0.5 mm length with known frequencycomponents produced by an etalon with an optical path of 2.0 mm so as todetermine an amplitude and a phase of reflected frequency components.

FIG. 11C illustrates measured interference signals for each of severalwavelengths as determined by a Fourier transform. An intensity 338 isshown at a spatial frequency 340 for each of several measuredinterference signals 342 of light reflected from a cornea. Eachinterference signal may be a complex number. As the frequencies ofreflected light are known, a digital filter in the form of a window 344may selectively pass measured frequencies matching frequencies of lightemitted by a source and transmitted by an etalon. For example, FIG. 11Aillustrates a spatial frequency 318 for each wavelength to be near 1250cycles per mm.

FIG. 11D illustrates positions of reflecting surfaces determined bycombining measured interference signals. An intensity 350 of reflectedlight in arbitrary units is shown at a position 334 for each of severalpositions. A first peak 352 and a second peak 354 are illustrated. Afirst peak 352 is located at a position of a reflecting anterior surfaceof a cornea, and a second peak 354 is located at a position of areflecting posterior surface of a cornea. Positions of other reflectingsurfaces and tissues of a cornea may be determined. For example, anentire optical path of an eye may be measured from a cornea to a retina.Also, optical properties such a tissue scattering may be measured.

Optical properties of a tissue may be determined over a distance alongan optical path by varying an optical path length of a reference mirroronly a fraction a distance along an optical path. As illustrated withreference to FIGS. 11A-11D, optical properties may be determined along a2 mm distance of an optical path by moving a mirror ½ mm. An entireoptical path of an eye having a distance of about 30 mm may be measuredby moving a mirror a distance of about 1 mm and less. A distance amirror is moved is related to a bandwidth and spatial frequencies ofreflected light components.

An inverse Fourier transform of several measured interference signalscombines several interference signals and determines an intensity ofreflected light along an optical path. An inverse transform may belimited to have spatial frequencies within a window of a filter asdescribed above. A Fourier transform of a limited band of frequenciesmay be referred to as a band limited Fourier transform. A band limitedtransform may exhibit oscillations around a peak in reflected intensityas illustrated near first peak 352 and second peak 354 of FIG. 11D.

FIG. 12 shows an embodiment integrating an optical pachymeter asdescribed above with a microscope 402 of a system as described above.The microscope 402 has one viewing port coupled to a camera 404, andanother viewing port coupled to a pachymeter 400. Microscope 402 may bea laser vision correction operating microscope commonly used in surgery,and provides a convenient coupling site for integrating a pachymeter400.

A measurement beam 410 generated by a optical pachymeter 400 is directedto a cornea via a microscope 402 in a slightly off-axis manner. Anoff-axis measurement can be compensated for by a correction factordetermined from geometric dimensions of the apparatus, and an off axisbeam may be directed slightly away from an apex of a cornea to providean increased amount of light reflected back into a microscope 402. FIG.12 illustrates an ablative beam 414 delivered by a beam delivery devicesuch as a scanner 416 to a cornea 4. In a specific embodiment, a scanner416 and a camera 402 are coupled together as indicated by electricalcommunication 420 to move synchronously. A system controller similar toa processor 22 of FIG. 1 may be in electrical communication with ascanner 416, a microscope 402, and a pachymeter 400 for controllingtheir operations.

It is to be understood that the above description is intended to beillustrative and not restrictive. Many embodiments will be apparent tothose of skill in the art upon reviewing the above description. Forinstance, an arrangement of optical elements for delivering ablative andmeasurement beams may be modified. Alternate tomography measurementdevices may be integrated with an ablative system. While specificreference has been made to an etalon and a Fourier transform, opticalwavelengths may be selected by other means and other transforms may beused. Therefore, the scope of the invention should be determined notwith reference to the above description, but instead should bedetermined with reference to the appended claims along with full scopeof their equivalents.

1. A method of treating a tissue, the method comprising: directing anablative beam for ablating the tissue via a scanning device to thetissue; directing a measurement beam for measuring a profile of thetissue via the scanning device to the tissue, wherein a path of theablative beam and a path of the measurement beam are substantiallyconcentric as directed onto the tissue.
 2. The method of claim 1 whereinthe path of the ablative beam and the path of the measurement beam aresubstantially coaxial as directed onto the tissue.
 3. The method ofclaim 1 further comprising measuring of the tissue intermittently attime intervals between instances of ablation.
 4. The method of claim 1wherein the measurement beam is directed to the tissue via the scanningdevice for measuring a thickness of the tissue.
 5. An apparatus forablating tissue, the apparatus comprising: an ablative light sourceproducing an ablative light beam; a measurement light source producing ameasurement light beam; and a scanner receiving the ablative beam fromthe ablative light source and the measurement beam from the measurementlight source, the scanner including optical elements for directing theablative beam and the measurement beam to locations across the tissue soas to ablate the tissue with the ablative beam and measure a profile ofthe tissue with the measurement beam, a path of the ablative beam and apath of the measurement beam being substantially concentric at thetissue.
 6. The apparatus of claim 5 wherein the path of the ablativebeam and the path of the measurement beam are substantially coaxial asdirected onto the tissue.
 7. The apparatus of claim 5 further comprisinga processor electrically connected with the ablative light source andthe measurement light source, the processor controlling of the ablativelight beam and the measurement light beam.